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Case Report
A case of apparent ART-associated immune reconstitution inflammatory syndrome in a patient with Strongyloides stercoralis infection
1 Resident, Internal Medicine, Lincoln Medical and Mental Health Center, Bronx, New York, United States of America
2 Division Chief of Infectious Disease, Infectious Disease, Lincoln Medical and Mental Health Center, Bronx, New York, United States of America
3 Attending, Infectious Disease, Lincoln Medical and Mental Health Center, Bronx, New York, United States of America
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Dwayvania Miller
Lincoln Medical and Mental Health Center, Bronx, New York,
United States of America
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Article ID: 100013Z16DM2023
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Miller D, Kilani Y, Ebhohon E, Keftassa E, Hennessey K, Feinstein A. A case of apparent ART-associated immune reconstitution inflammatory syndrome in a patient with Strongyloides stercoralis infection. J Case Rep Images Infect Dis 2023;6(1):1–6.ABSTRACT
Introduction: Strongyloides infection is most commonly caused by Strongyloides stercoralis (S. stercoralis). It often causes asymptomatic chronic infection but through the translocation of the parasite into the bloodstream, it can lead to disseminated strongyloidiasis (DS). We describe a case of a patient with human immunodeficiency virus (HIV) who developed Strongyloidiasis with the complication of vancomycin-resistant Enterococcus (VRE) meningitis. Notably, the clinical condition of the patient worsened after commencing anti-retroviral therapy (ART), raising concern for ART-associated immune reconstitution inflammatory syndrome (IRIS) to S. stercoralis.
Case Report: A 51-year-old African female with a past medical history of HIV presented with a 1-week history of abdominal pain and a 2-month history of generalized malaise, constipation, and weight loss. She improved with symptomatic management and commenced Biktarvy. She re-presented one month later with worsening gastrointestinal symptoms. Her hospital course was complicated by septicemia with worsening mentation. Her repeat abdominal imaging showed ascending and transverse colitis and cerebrospinal fluid analysis was positive for vancomycin-resistant Enterococcus faecium (VRE). During her re-admission, the patient developed persistent watery diarrhea which was found to be positive for S. stercoralis. Despite medical therapy she demised on day 28 of admission.
Conclusion: Literature is very scarce concerning the progression of S. stercoralis infection to Strongyloides disseminated strongyloidiasis (DS) as a result of IRIS. As clinicians, we must have a high index of suspicion in our HIV population as DS can lead to fatal complications. It can also help guide management decisions concerning ART until complete eradication of S. stercoralis infection is obtained.
Keywords: Disseminated strongyloidiasis, IRIS, Strongyloidiasis, Strongyloides stercoralis
SUPPORTING INFORMATION
Acknowledgments
Lincoln Medical and Mental Health Center Medical Floor and MICU Department for the management of this patient during her hospital stay
Author ContributionsDwayvania Miller - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Yassine Kilani - Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Ebehiwele Ebhohon - Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Emnet Keftassa - Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Karen Hennessey - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Addi Feinstein - Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the verbal consent obtained from patient’s next of kin for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2023 Dwayvania Miller et al.. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
